An Evidence-based Manual for Abdominal Paracentesis

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2007 Mar 30

PMID 17393312

Citations 15

Authors

Angela McGibbon

Grant I Chen

Kevork M Peltekian

Sander Veldhuyzen Van Zanten

Affiliations

Soon will be listed here.

Abstract

The purpose of this study was to provide evidence-based approaches to detect ascites, perform paracentesis, order tests, and interpret the results. A Medline search was performed to identify relevant articles. Of 731 identified articles, 50 articles were used. The most sensitive findings for ascites detection are ankle edema (93%), increased abdominal girth (87%), flank dullness (84%), and bulging flanks (81%). Paracentesis is safe, with bleeding rates and leakage of <1%. An ascitic fluid polymorphonuclear cell count >or=250 cells/mm(3) is the most sensitive test (86%-100%) to diagnose spontaneous bacterial peritonitis. The serum-ascites albumin gradient is the most useful test in identifying portal hypertension-related ascites. Large-volume paracentesis is effective in the treatment of refractory ascites. We conclude that paracentesis is a safe and vital procedure in patients with new-onset ascites. Once detected, an algorithmic approach to ordering tests and their interpretation is useful to determine etiology and direct further management.

Citing Articles

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Enhancing proficiency in ascites puncture through procedural simulation: an audit type study investigating medium-term skill retention.

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